Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4528 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 73 81 126.404763 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 73 81 126.404763 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 13 14 23.353424 $1751.5100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 22.500000 $1687.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 8 8 14.011111 $1050.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 7.500000 $562.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 22 22 37.000000 $2053.5000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 21.659056 $1202.0700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 25 25 50.000000 $3750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 84 84 154.680821 $11601.0700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 22.500000 $1687.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 59 59 113.505479 $8512.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 39 39 71.500000 $5362.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 68 69 132.405479 $9930.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 106 107 206.500000 $11460.7500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 118 119 215.591779 $11965.3500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.161111 $8.2800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 37 39 20.790639 $1068.8400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.144444 $7.4200 $51.3900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 8 4.038890 $207.6400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.461111 $23.7100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 2.333333 $119.9600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 56 59 27.167580 $1396.6900 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 6 6 2.722223 $139.9500 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 22 19.327778 $993.6400 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.126027 $6.4800 $51.4000
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 26 16.429833 $844.6600 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.408219 $72.4000 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 27 30 22.705707 $1167.3100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.158904 $59.5800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 3.000000 $154.2300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.477778 $24.5600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 7.000000 $359.8700 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.266667 $13.7100 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 58 66 29.310427 $1506.8500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 1.461110 $75.1100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.272222 $65.4000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.500000 $112.1500 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 36.142857 $1913.0400 $52.9300
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Subtotal (Total Children Is Unduplicated) 482 902 1323.614009 $85113.0300 $64.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 30 25.030137 $125151.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 69 80.554762 $4027.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 29 36 41.454760 $2072.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 10.500000 $262.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 524 659 878.115067 $43905.7400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 148 175 250.630152 $12531.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.677778 $16.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 205 253 340.288887 $17014.4400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 127 149 219.592065 $10979.6100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.988889 $24.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 153 217 225.631743 $11281.5900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 74 109 101.130950 $5056.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 340 433 520.519436 $26025.9600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 155 191 250.205552 $12510.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 8.238889 $205.9700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.533333 $38.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 31 33 260.571427 $13028.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 532 694 4738.003740 $236900.0300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 78 96 634.196819 $31709.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4 5 28.285714 $282.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 90 563.028573 $40515.5000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 14.961904 $1076.6600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 24.142858 $1737.3200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 65 94 523.416661 $37665.1000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 10 12 71.357140 $5134.8700 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 4 5 24.314285 $1749.6600 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 6 39.780952 $2862.6400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 95 130 671.076976 $48290.7400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 11 15 47.338097 $3406.4500 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 6 45.285714 $3258.7600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 20.500000 $1475.1700 $71.9600
TRAV -TRAVS Travel by mile 4 5 88.428571 $39.3500 $0.4400
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Subtotal (Total Children Is Unduplicated) 708 3545 10749.781831 $700239.0800 $65.1400
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Total 4528 12199.800603 $785352.1100 $64.3700
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Number of Children (Unduplicated) With at Least One Authorization 871